GLEN WILLIS

CORAM, NY
NPI1326585902
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy164W00000X Licensed Practical Nurse
(Licence: NY  310633-1)
Enumeration Date2017-01-20
Last Update Date2017-01-20
Business Address
MR. GLEN WILLIS LPN
1807 RUGBY PL APT B
CORAM, NY 11727-5427
Phone number: 631-627-9455
Mailing Address
MR. GLEN WILLIS LPN
1807 RUGBY PL APT B
CORAM, NY 11727-5427
Phone number: 631-627-9455
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